COUNTRYSIDE MANOR, INC
Assisted Living Facility
Stokesdale, North Carolina
Provider NPI: 1992790810
Organization Information:Organization Name: COUNTRYSIDE MANOR, INC
Practice Location:
7700 US HIGHWAY 158 STOKESDALE, NC 27357 US
Tel: 336-643-6301 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
7700 US HIGHWAY 158 STOKESDALE, NC 27357 US
Tel: 336-643-6301 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
X | 310400000X | Nursing & Custodial Care Facilities Assisted Living Facility | NC | NH0226 |
X | 313M00000X | Nursing & Custodial Care Facilities Nursing Facility/Intermediate Care Facility | NC | NH0226 |
X | 314000000X | Nursing & Custodial Care Facilities Skilled Nursing Facility | NC | NH0226 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
3416145 | NC | 05 | |
3415390 | NC | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin